Value congruence in health care priority setting: social values, institutions and decisions in three countries

AbstractMost developed democracies have faced the challenge of priority setting in health care by setting up specialized agencies to take decisions on which medical services to include in public health baskets. Under the influence of Daniels and Sabin’s seminal work on the topic, agencies increasingly aim to fulfil criteria of procedural justice, such as accountability and transparency. We assume, however, that the institutional design of agencies also and necessarily reflects substantial value judgments on the respective weight of distributive principles such as efficiency, need and equality. The public acceptance of prioritization decisions, and eventually of the health care system at large, will ultimately depend not only on considerations of procedural fairness, but also on the congruence between a society’s values and its institutions. We study social values, institutions and decisions in three countries (France, Germany and the United Kingdom) in order to assess such congruence and formulate expectations on its effects.

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Health Priority Setting in Iran: Evaluating Against the Social Values Framework

Global Journal of Health Science ◽

10.5539/gjhs.v8n10p212 ◽

2016 ◽

Vol 8 (10) ◽

pp. 212

Author(s):

Hakimeh Mostafavi ◽

Arash Rashidian ◽

Mohammad Arab ◽

Mohammad R. V. Mahdavi ◽

Kioomars Ashtarian

Keyword(s):

Health Care ◽

Health System ◽

Priority Setting ◽

Social Values ◽

City Council ◽

Decision Makers ◽

The Public ◽

Health Technologies ◽

Health Priority ◽

The Social

Background: Health systems, as part of the social system, consider public values. This study was conducted to examine the role of social values in the health priority setting in the Iranian health system.Methods: In this qualitative case study, three main data sources were used: literature, national documents, and key informants who were purposefully selected from health care organizations and other related institutions. Data was analyzed and interpreted using the Clark-Weale Framework.Results: According to our results, the public indirectly participates in decision-making. The public representatives participate in the meetings of the health priority setting as parliament members, representatives of some unions, members of the city council, and donors. The transparency of the decisions and the accountability of the decision makers are low. Decision makers only respond to complaints of the Audit Court and the Inspection Organization. Individual choice, although respected in hospitals and clinics, is limited in health care networks because of the referral system. Clinical effectiveness is considered in insurance companies and some hospitals. There are no technical abilities to determine the cost-effectiveness of health technologies; however, some international experiences are employed. Equity and solidarity are considered in different levels of the health system.Conclusion: Social values are considered in the health priority decisions in limited ways. It seems that the lack of an appropriate value-based framework for priority setting and also the lack of public participation are the major defects of the health system. It is recommended that health policymakers invite different groups of people and stakeholders for active involvement in health priority decisions.

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Participation in health care priority-setting through the eyes of the participants

Journal of Health Services Research & Policy ◽

10.1258/135581902320432750 ◽

2002 ◽

Vol 7 (4) ◽

pp. 222-229 ◽

Cited By ~ 47

Author(s):

Douglas Martin ◽

Julia Abelson ◽

Peter Singer

Keyword(s):

Health Care ◽

Decision Making ◽

Qualitative Study ◽

Priority Setting ◽

Decision Makers ◽

Medical Specialist ◽

Committee Chair ◽

The Public ◽

Health Care Priority Setting ◽

Patient Representative

Objectives: The literature on participation in priority-setting has three key gaps: it focuses on techniques for obtaining public input into priority-setting that are consultative mechanisms and do not involve the public directly in decision-making; it focuses primarily on the public's role in priority-setting, not on all potential participants; and the range of roles that various participants play in a group making priority decisions has not been described. To begin addressing these gaps, we interviewed individuals who participated on two priority-setting committees to identify key insights from participants about participation. Methods: A qualitative study consisting of interviews with decision-makers, including patients and members of the public. Results: Members of the public can contribute directly to important aspects of priority-setting. The participants described six specific priority-setting roles: committee chair, administrator, medical specialist, medical generalist, public representative and patient representative. They also described the contributions of each role to priority-setting. Conclusions: Using the insights from decision-makers, we have described lessons related to direct involvement of members of the public and patients in priority-setting, and have identified six roles and the contributions of each role.

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Procedural justice and democratic institutional design in health-care priority-setting

Contemporary Political Theory ◽

10.1057/cpt.2012.28 ◽

2013 ◽

Vol 12 (4) ◽

pp. 296-317 ◽

Cited By ~ 10

Author(s):

Claudia Landwehr

Keyword(s):

Health Care ◽

Procedural Justice ◽

Priority Setting ◽

Institutional Design ◽

Health Care Priority Setting

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Strategic Institutional Design: Two Case Studies of Non-Majoritarian Agencies in Health Care Priority-Setting

Government and Opposition ◽

10.1017/gov.2014.37 ◽

2014 ◽

Vol 51 (4) ◽

pp. 632-660 ◽

Cited By ~ 6

Author(s):

Claudia Landwehr ◽

Katharina Böhm

Keyword(s):

Health Care ◽

Case Studies ◽

Priority Setting ◽

Institutional Design ◽

Policy Decisions ◽

Blame Avoidance ◽

Health Care Priority Setting ◽

Strategic Motives ◽

Selection Of

Governments’ decisions to delegate policy decisions to non-majoritarian agencies have been both criticized as attempts at blame avoidance or depoliticization and defended as enhancing the rationality and credibility of decisions. This article focuses not on the decision to delegate, but on the decisions of how and to whom to delegate. We argue that strategic motives are relevant not only in the decision to delegate, but equally, and perhaps more importantly, in the selection of the institutional properties of these non-majoritarian agencies. We present two case studies of health care priority-setting, in England and Germany, to illustrate how governments proceed strategically in institutional design choices and how their decisions affect outcomes.

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Evaluation of a deliberative approach to citizen involvement in health care priority setting

Leadership in Health Services ◽

10.1108/lhs-01-2013-0002 ◽

2014 ◽

Vol 27 (1) ◽

pp. 5-19 ◽

Cited By ~ 7

Author(s):

Iestyn Williams ◽

Daisy Phillips ◽

Charles Nicholson ◽

Heather Shearer

Keyword(s):

Primary Care ◽

Health Care ◽

Decision Making ◽

Public Engagement ◽

Priority Setting ◽

Primary Care Trust ◽

Content Type ◽

The Public ◽

Novel Approach ◽

Health Care Priority Setting

Purpose – The purpose of this paper is to describe and evaluate a novel approach to citizen engagement in health priority setting carried out in the context of Primary Care Trust (PCT) commissioning in the English National Health Service. Design/methodology/approach – Four deliberative events were held with 139 citizens taking part in total. Events design incorporated elements of the Twenty-first Century Town Meeting and the World Café, and involved specially-designed dice games. Evaluation surveys reporting quantitative and qualitative participant responses were combined with follow-up interviews with both PCT staff and members of the public. An evaluation framework based on previous literature was employed. Findings – The evaluation demonstrates high levels of enjoyment, learning and deliberative engagement. However, concerns were expressed over the leading nature of the voting questions and, in a small minority of responses, the simplified scenarios used in dice games. The engagement exercises also appeared to have minimal impact on subsequent Primary Care Trust resource allocation, confirming a wider concern about the influence of public participation on policy decision making. The public engagement activities had considerable educative and political benefits and overall the evaluation indicates that the specific deliberative tools developed for the exercise facilitated a high level of discussion. Originality/value – This paper helps to fill the gap in empirical evaluations of deliberative approaches to citizen involvement in health care priority setting. It reports on a novel approach and considers a range of implications for future research and practice. The study raises important questions over the role of public engagement in driving priority setting decision making.

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What should guide priority setting in health care? A study of public preferences in Sweden

Nordic Journal of Health Economics ◽

10.5617/njhe.6159 ◽

2019 ◽

Author(s):

Linda Ryen ◽

Niklas Jakobsson ◽

Mikael Svensson

Keyword(s):

Health Care ◽

Disease Severity ◽

Priority Setting ◽

Treatment Cost ◽

Multinomial Logistic Regression ◽

Public Preferences ◽

The Public ◽

Trade Offs ◽

Sample Proportion ◽

Health Care Priority Setting

Priority setting criteria in health care are commonly set by politicians on behalf of the public. It is desirable that these criteria are in line with societal preferences in order to gain acceptance for decisions on what health services to provide and reimburse. We study public preferences for the allocation of the health care budget based on age, disease severity and treatment cost. We use data from a web survey where 1,160 respondents provided their views on priority setting criteria in health care. The data was analyzed using multinomial logistic regression analyses and one-sample proportion tests. Between 13 to 25 percent of the respondents agree that age, disease severity and treatment cost are valid criteria for priority setting, whereas 56 to 80 percent support weaker versions of the statements. We also find significant differences within the population; young men are for example more prone to support explicit priority setting criteria. Our results imply a need for trade-offs in health care priority setting if balancing differing preferences among population groups. To achieve a greater understanding for priority setting in general, and for using economic reasoning in particular, there may be a need for more public transparency to make clear that priority setting is inevitable. Published: Online December 2019

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Cultural mediators are needed to fulfill Right to health for all

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.672 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Magnusson ◽

I-Z Jama

Keyword(s):

Public Health ◽

Health Care ◽

Life Style ◽

Right To Health ◽

Healthy Life ◽

The Public ◽

Cultural Mediators ◽

Healthy Life Style ◽

The Right ◽

Health Planner

Abstract The Right to health framework supports available, accessible and acceptable health care of high quality for all (AAAQ). Health of migrants often worsen in the new country. AAAQ may be hindered by poverty, discrimination, health cares' shortcomings and misunderstandings, respectively. Advocating for marginalised groups' Right to health include action. Interventions based on shared influence, participation and control need to be launched. Cultural mediators (CM), i.e. persons that are knowledgeable in both cultures and with networks in migrant groups help overcome lingual problems, lack of trust and uneven power relations. This resource needs to be further examined. How can a CM strengthen AAAQ in a public health setting? Women with Somalian origin living in an underserved neighborhood in Sweden contacted the Public Health Unit of a local hospital, asking for support for a health focused group-activity. Weight loss after delivery was a primary concern. Women gathered monthly 2018-19. The objective was to support healthy life style habits drawing on issues raised by the women. The intervention was conducted by group talks, led by the CM and a public health planner. Methods were based on Social Cognitive Theory focusing on self-efficacy. The CM recruited women, helped them to find the venue, encouraged them to trust the public health planner and broadened perspectives to include female genital mutilation, children's food, how to seek care and workforce issues. Trust developed over time. 70 women participated. Reported gains were raised awareness of ones' rights, increased self-efficacy in relation to food, physical activity and how to support children to a healthy life style. Support for a healthy lifestyle was made more available, accessible and acceptable by the cooperation with the CM, as was the quality of the support. A CM bridges distances regarding spoken language, trust and cultural understanding. S/he puts forward perspectives and needs from the group in question Key messages The Right to health framework highlights areas that need to be in focus when advocating for health equity. Health care workers in settings with many migrants should strive to include cultural mediators in planning, execution and evaluation of interventions.

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